Habilitation, Healthy Agency, and Patient-Participation

Habilitation, Healthy Agency, and Patient-Participation

Lawrence C. Becker (Hollins University, USA)
DOI: 10.4018/978-1-4666-9992-2.ch001


This chapter argues, on ethical grounds, that wherever possible patient-participation must be kept consistent with the level of healthy rational agency that is, or might be, available to the patient. Merely compliant patient-participation is not enough. This is also true of patient-adaptation or adjustment. Mere adaptive compliance is not enough. Accepting patient-consent, cooperation, and compliance as an adequate indication of genuine agentic participation is often hard to avoid, but such acceptance is also often inconsistent with appropriate healthcare. These conclusions follow, as a matter of empirically informed practical ethics, from an analysis of the lifelong habilitative tasks that face every human being, and the role that the patient's healthy agency plays in the development, protection, or restoration of the patient's agency itself and the patient's basic good health generally.
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The Aims of This Chapter and Its Relation to the Book as a Whole

The purpose of this chapter is to argue for the practical and ethical importance, in all healthcare contexts, of a certain conception of individual human agency – called here “healthy” agency. This form of agency is too often neglected or underemphasized in philosophy, psychology, and healthcare contexts.

In philosophy, this happens when discussions of agency are confined to metaphysical or moral problems about agent causation, volition, and moral responsibility. See, for a recent book length example, Understanding Human Agency (Mayr, 2011). In psychology, it happens when agentic activity is thought of in terms of the individual’s consciously self-centric pursuits, either together with or in opposition to more communal ones. See the recent anthology called Agency and Joint Attention (Metcalfe & Terrace, 2013).

As other chapters in the present volume will show, explicitly or implicitly, a distinction between active agents and passive patients is readily available in healthcare contexts. Moreover, in some healthcare contexts a persistent effort is made to engage patients’ active agentic powers in their own wellness and healthcare treatment programs. Nonetheless, situations abound in which the health of the patient’s agency is neglected in healthcare research, policy, funding, and treatment decisions. Instead, it is relegated to matters of nonmedical training rather than medical treatment, and coaching rather than therapy.

This does not happen as much, of course, in places where healthy agency is by definition close to the center of treatment concerns – for example in “performance medicine” for soldiers, athletes, and other high-risk and high stress occupations, and in behavioral health contexts for people who are persistently self-destructive or compulsively antisocial. Even there, however, the relatively meager social resources allocated to the problems of agentic health may lead to its neglect in practice.

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